NUR 5461 ADVANCED PATHOPHYSIOLOGY EXAM
1 REVIEW – ORIGINAL PRACTICE QUESTIONS
AND DETAILED RATIONALES | WILLIAM
PATERSON UNIVERSITY | 100 ORIGINAL STUDY
QUESTIONS
Core Domains
• Cellular Injury, Adaptation, and Death
• Inflammation and Wound Healing
• Immunity and Hypersensitivity Reactions
• Genetics and Genetic Disorders
• Neoplasia and Carcinogenesis
• Fluid, Electrolyte, and Acid-Base Balance
• Hematologic Alterations
• Cardiovascular Pathophysiology
• Pulmonary Pathophysiology
• Renal and Neurologic Pathophysiology
Introduction
This practice examination assesses advanced pathophysiologic knowledge required
for graduate nursing practice. The examination evaluates competency in cellular
injury and adaptation, inflammatory and immune responses, genetic inheritance
patterns, carcinogenesis, fluid and electrolyte derangements, hematologic
,disorders, and the pathophysiology of cardiovascular, pulmonary, renal, and
neurologic systems. Questions are structured to require mechanism-level
reasoning rather than rote recall, emphasizing the molecular and physiologic
processes that underlie clinical manifestations. Emphasis is placed on connecting
etiologic mechanisms to diagnostic findings and targeted therapeutic interventions
across the lifespan.
SECTION ONE: QUESTIONS 1–100
1. A cell swells and loses its ability to regulate ion balance after ATP depletion.
Which mechanism best explains this finding?
A. Failure of the sodium-potassium ATPase pump
B. Increased intracellular potassium
C. Activation of apoptosis
D. Lysosomal rupture
A. Failure of the sodium-potassium ATPase pump
RATIONALE: ATP depletion causes failure of the Na+/K+-ATPase pump,
allowing sodium and water to accumulate intracellularly, producing cellular
swelling — the hallmark of reversible hypoxic injury.
2. Which form of cell death is characterized by controlled, energy-dependent
dismantling of the cell without triggering inflammation?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Apoptosis
D. Caseous necrosis
C. Apoptosis
, RATIONALE: Apoptosis is an ATP-dependent, programmed process that
packages cellular contents into apoptotic bodies for phagocytosis, avoiding the
inflammatory response seen with necrosis.
3. A patient with a myocardial infarction has a region of dead myocardium with
preserved tissue architecture. Which type of necrosis is present?
A. Liquefactive
B. Coagulative
C. Fat
D. Fibrinoid
B. Coagulative necrosis
RATIONALE: Coagulative necrosis results from ischemia and is characterized
by preservation of tissue architecture with loss of nuclei. It is typical of ischemic
injury in heart, kidney, and spleen.
4. Which cellular adaptation involves a decrease in cell size and is commonly
seen in disuse atrophy?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
C. Atrophy
RATIONALE: Atrophy is a decrease in cell size due to reduced workload,
decreased blood supply, or hormonal withdrawal, resulting in diminished organ
mass.
, 5. Replacement of normal columnar bronchial epithelium with stratified
squamous epithelium in a chronic smoker represents which adaptation?
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Hyperplasia
B. Metaplasia
RATIONALE: Metaplasia is the reversible replacement of one mature cell type
with another better able to withstand stress. In smokers, squamous metaplasia
replaces ciliated columnar epithelium.
6. Which mediator is primarily responsible for the vasodilation and increased
vascular permeability seen in acute inflammation?
A. Histamine
B. Interleukin-2
C. Immunoglobulin G
D. Complement C3b
A. Histamine
RATIONALE: Histamine, released by mast cells, causes arteriolar vasodilation
and increased capillary permeability, producing the classic heat, redness, and
swelling of acute inflammation.
7. Which cell type is the first to arrive at the site of acute inflammation?
A. Lymphocyte
1 REVIEW – ORIGINAL PRACTICE QUESTIONS
AND DETAILED RATIONALES | WILLIAM
PATERSON UNIVERSITY | 100 ORIGINAL STUDY
QUESTIONS
Core Domains
• Cellular Injury, Adaptation, and Death
• Inflammation and Wound Healing
• Immunity and Hypersensitivity Reactions
• Genetics and Genetic Disorders
• Neoplasia and Carcinogenesis
• Fluid, Electrolyte, and Acid-Base Balance
• Hematologic Alterations
• Cardiovascular Pathophysiology
• Pulmonary Pathophysiology
• Renal and Neurologic Pathophysiology
Introduction
This practice examination assesses advanced pathophysiologic knowledge required
for graduate nursing practice. The examination evaluates competency in cellular
injury and adaptation, inflammatory and immune responses, genetic inheritance
patterns, carcinogenesis, fluid and electrolyte derangements, hematologic
,disorders, and the pathophysiology of cardiovascular, pulmonary, renal, and
neurologic systems. Questions are structured to require mechanism-level
reasoning rather than rote recall, emphasizing the molecular and physiologic
processes that underlie clinical manifestations. Emphasis is placed on connecting
etiologic mechanisms to diagnostic findings and targeted therapeutic interventions
across the lifespan.
SECTION ONE: QUESTIONS 1–100
1. A cell swells and loses its ability to regulate ion balance after ATP depletion.
Which mechanism best explains this finding?
A. Failure of the sodium-potassium ATPase pump
B. Increased intracellular potassium
C. Activation of apoptosis
D. Lysosomal rupture
A. Failure of the sodium-potassium ATPase pump
RATIONALE: ATP depletion causes failure of the Na+/K+-ATPase pump,
allowing sodium and water to accumulate intracellularly, producing cellular
swelling — the hallmark of reversible hypoxic injury.
2. Which form of cell death is characterized by controlled, energy-dependent
dismantling of the cell without triggering inflammation?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Apoptosis
D. Caseous necrosis
C. Apoptosis
, RATIONALE: Apoptosis is an ATP-dependent, programmed process that
packages cellular contents into apoptotic bodies for phagocytosis, avoiding the
inflammatory response seen with necrosis.
3. A patient with a myocardial infarction has a region of dead myocardium with
preserved tissue architecture. Which type of necrosis is present?
A. Liquefactive
B. Coagulative
C. Fat
D. Fibrinoid
B. Coagulative necrosis
RATIONALE: Coagulative necrosis results from ischemia and is characterized
by preservation of tissue architecture with loss of nuclei. It is typical of ischemic
injury in heart, kidney, and spleen.
4. Which cellular adaptation involves a decrease in cell size and is commonly
seen in disuse atrophy?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
C. Atrophy
RATIONALE: Atrophy is a decrease in cell size due to reduced workload,
decreased blood supply, or hormonal withdrawal, resulting in diminished organ
mass.
, 5. Replacement of normal columnar bronchial epithelium with stratified
squamous epithelium in a chronic smoker represents which adaptation?
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Hyperplasia
B. Metaplasia
RATIONALE: Metaplasia is the reversible replacement of one mature cell type
with another better able to withstand stress. In smokers, squamous metaplasia
replaces ciliated columnar epithelium.
6. Which mediator is primarily responsible for the vasodilation and increased
vascular permeability seen in acute inflammation?
A. Histamine
B. Interleukin-2
C. Immunoglobulin G
D. Complement C3b
A. Histamine
RATIONALE: Histamine, released by mast cells, causes arteriolar vasodilation
and increased capillary permeability, producing the classic heat, redness, and
swelling of acute inflammation.
7. Which cell type is the first to arrive at the site of acute inflammation?
A. Lymphocyte
